NCLEX Study Guide / NCLEX review class

NCLEX Study Guide / NCLEX review class If Infancy The Toddler PRESCHOOLER Preschooler Stops School Age Acting Adolescence YOUNG Young Adulthood ADULTHOOD Aduilthood Ensues Elderly Infancy 0 – 18 months Trust vs Mistrust Toddler 18 months – 3 yrs Autonomy vs Self Doubt Preschooler 4 - 6 yrs Initiative vs Guilt School Age 6 – 12 yrs Industry vs Inferiority Adolescence 13 – 18 yrs Identity vs Role Confusion Young Adulthood 19 – 39 Intimacy vs Isolation Adulthood 40 – 64 Generativity vs Stagnation Elderly 65 and over Integrity vs Despair Do’s Don’ts Stay and Protect Lie Tell the Truth Make False Promises Use simple terms (check development status) Put down patient Seek information Enhance Negative behavior (mental illness symptoms) Be Judgemental Locus of Decision Making – When RN can make own judgements When to turn comatose patient Type of feeding schedule (via tube) Force patient to take meds when they threaten to harm someone Plan care with Chronically Ill patients to effect lifestyle changes (99% of decision making is this way) INFORMATION NOTE: All behavior has meaning. The meaning is to reduce anxiety. Those at most risk for Gall Bladder Surgery FFFF Fair Fat Fifty Female Growth and Development Infancy 0 – 18 months Trust vs Mistrust Physiological care most important Diarrhea can be devastating. (Baby 50 – 80% water) May lead to: Dehydration Fluid / Electrolyte Imbalance Metabolic Acidosis 1st priority to isolate baby who could have infection 1st six months baby only needs breast milk Iron stored in utero not needed for six months Baby would get iron supplement if born @ 35 weeks Give new foods one at a time to check for allergens Baby doubles weight in first six months Baby gains weight at 6 to 8 ox / week Baby Triples weight by 1 yr If weight gain not adequate = Failure to Thrive Typical Problems at this age: CLEFT PALATE / LIP Not much known about causes Ducky Nipple used for sucking Cleft Lip closed at 6 to 12 weeks Cleft Palate closed at 12 to 18 months Waiting for maximum growth before speech age Baby can breast feed with either problem Cleft Lip = cheiloplasty Cleft Plate = Palatoplasty Post op care is to avoid trauma to surgical site Prevent baby from touching surgical site Keep site clean / avoid infection PKU Can cause mental retardation Some symptoms can include behavior changes that mimic psychosis No enzyme to digest Phenalalanine. Builds up and causes cessation of brain growth Guthrie Blood Test is for PKU. Tests for excessive amounts of Phenylalanine Performed within 7 days after birth as a HEEL STICK just after baby eats some protein Tx = low phenylalanine diet. Levels checked Nutrasweet & Equal become phenylalanine in the body 12 oz can of diet drink doesn’t raise levels much Very Restrictive Diet Initially till 14 yrs old At 14 yrs old brain gorwth 80% Brain fully formed at 18 NO restaurants, NO Parties Diet = 1 % protein / veggies (Protein contains a lot of Phenylalanine) Celiac Dsiease (Think Gluten Intolerance) Effects small intestines Malabsorption Syndrome (teacher says metabolism problem) Teacher says no enzyme to digest gluten Gluten found in Wheat, Rye, Barley, Oats (BROW) First evidence of problem = failure to thrive, diarrhea Stool are oily, foul smelling, and frothy Corn and rice substituted for other grains. Cystic Fibrosis (Think Genetic Anomoly) Autosomal Recessive Trait (both parents have recessive gene) Earliest manifestation = meconium Ilieus in newborn Meconium Ileus = small intestine blocked by thick mucousy meconium Mucous also blocks pancreatic ducts blocking enzymes to duodenum Causes impairment of digestion and absorption Stool can be bulky, frothy, oily, and foul smelling (undigested fat = steatorrhea) Often associated with prolapse of rectum and impaction / intestinal obstruction Thick mucous builds up in lungs. Hard to expectorate Patient has high concentration of Na and Cl in sweat Patients fed high calorie, high protein, low fat meals Need to take pancreatic enyzmes with EVERYTHING THEY EAT SIDE NOTES: Preterm is not same as Premature Premature = 5 lbs If child doesn’t prefer mom at 2 yrs old think child abuse There are 3 autosomal recessive illnesses Taysachs Sickle Cell Cystic Fibrosis There are 3 types of patients who should eat salty snacks Cystic Fibrosis CHF using Lasix + dehydration from heat Pts on Lithium EXAM TIP: Notifying the Physician is the last resort. There is usually something for a NURSE to do before calling them. NOTES PERTAINING TO FIRST PRACTICE EXAM 1. Head and chest circumference = Newborn assessment technique (Head = chest circumference otherwise suspect hydrocephalus 2. Reason for a brain shunt is to PREVENT TISSUE DAMAGE 3. ? 4. ? Monitor Temperature of newborn. Babies can be hypothermic Check vital signs in following order: Respirations HR Temperature 5. Vomiting 6. Length changes 7. Best way to open airway is to hyperextend and lower jaw 8. Most likely reaction to plastic ingestion is pyrogenic reaction (fever) 9. operative side near diaphragm for patient with subtotal Gastrectomy (partial stomach removal) 10. Need Na when gastric suctioning 11. If 3,000 cc fluids / 24 hours must watch for circulatory overload 12. 13. post op patient needs sterile solution / equipment 14. smaller than avg for period of time? 15. Non communicating hydrocephalus – blockage of drainage of CSF. Rapid passage large amts hypertonic fluid? 16. Fainters. Check sweating, palpatations (same as shock) ? 17. Day one for tracking of menstrual cycle is when bleeding starts? 18. Keep checking basal temp when taking clomide 19. Over 35 check chromosomes via amniocentesis @ 16 weeks 20. Preeclampsia ? 21. You feel breast feeding is difficult? (answer if father thinks it is) 22. Placenta previa (occurs when multiple babies at risk) ? 23. When uterus relaxes between contractions ? 24. Baby can raise head and shoulders at 5 months 25. Should sit up at 6 months 26. Weight doubles at 6 months and triples at 1 yr 27. ? To prevent dumping syndrome (occurs after subtotal gastrectomy) patient should eat high protein, high fat, low concentrated carbs, and dry meals. Should have fluids 2 hrs before or after meals (No SOUP). If dumping occurs stop eating, lay down (not flat). With stomach removal surgery may need B12 injections to avoid pernicious anemia. NOTES PERTAINING TO SECOND PRACTICE EXAM 1. Legally blind is 20/200 in better eye with corrective lenses 2. 3. Carbohydrates needed with protein for tissue repair 4. 5. To protect against tearing use lubricant (for what problem?) 6. 7. 8. 9. 10. Diastolic more important in HTN (worst case value when heart NOT pumping) 11. 12. Most important to discuss Stressors with HTN patient 13. 14. Left ventricle failure is pumping against resistance during ? 15. 16. Drowziness earliest sign of Uremia (kidneys stop working) 17. 18. 19. Talking about whats bothering them may be unpleasant but may bring relief. (what to say if patient says why talk to a nurse when he can talk to a doctor?) 20. 21. If patient flees from room filled with other patients STAY with patient in THEIR Room 22. Fear has a specific object 23. 24. If patient has anxiety attack patient can sit in hallway at nurses station 25. 26. Repression is best defense mechanism 27. Denial most common way to deal with Neurosis 28. Malingering = pretending to have symptoms of mental or physical illness 29. Under conscious control ? 30. Most frequent neurotic reaction of childhood is a phobia 31. 32. relaxing of smooth mucsle = constipation ? 33. 33. When a mother apologizes for not knowing when to come to hospital (when in labor) correct statement to make is “ It’s difficult for mothers to know when to come to the hospital.” 35. 36. no pain meds given before birth depresses respiratory response in baby 37. 38. State makes laws regarding health care 39. Check fundus and lockia (when?) 40. Golden yellow mushy stool when baby breast feeding 41. 42. yellow tinge in Sclera (what was question?) 43. ??? Listen to women who have had babies before ???? what question about? Topics exams covered that I need to cover: Vascular Ulcers TURP post surgical care HTN (essential) Cardiac Decompensation Uremia – symptoms What’s hysterical reaction Normal Discomforts of Pregnancy First Trimester Pain / Tingling in breasts (also sign of pregnancy) Urgency / freq urination (if in second tri = problem = UTI) Languor (no energy) / malaise Nausea / Vomiting Second Trimester Constipation (cure with fluids, fiber, activity) Heartburn Increased Pigmentation Leg cramps (nites) Pica Third Trimester Hemorrhoids (varicose veins of anus) Varicosities Leg cramps Joint Hypermobility (feel twitchy) Urgency / freq urination Bachache Danger Signals of Pregnancy Visual Disturbances (associated with HTN / Preeclampsia) Blurring Double vision Spots Swelling of face and fingers Severe, freq, or continuous headaches Muscular irritability or convulsions Epigastric pain (ectopic preg?) Persistent vomiting post first trimester / severe vomiting any time (see hypermesis gravidarum = weight loss of 5% of prepregnancy weight Dehydration Electrolyte imbalance Ketosis Acetonuria Vaginal Discharge either blood or amniotic fluid (ask color and if pain) Signs of infection i.e. chills, fever (should not self medicate) Burning on urination = UTI Severe / Unusual pain in abdomen (may be abrupto placenta = separation of placenta from uterus = board like abdomen) No fetal movement after quickening (after baby moves into position for birth) Maternal Tasks Accept that she’s pregnant (1st trimester) “I’m going to have a baby” (2nd trimester) – time for nurse to recommend healthy things i.e. give up cigs, & coffee father may feel left out “I am going to be a Parent” Know Stages of Delivery Either in active labor or not, no latent or prodromal phases on exam Onset of true rhythmic contractions = contractions don’t disappear when ambulating 1st stage begins with labor and ends with 100% cervical dilation (10 cm) and effacement Transition (last portion of first stage) is from 8 to 10 cm 2nd stage begins with end of 1st stage 100% dilation & effacement and ends with delivery (end of 2nd stage (transitional phase) takes about 20 mins) 3rd stage begins with birth and ends with expulsion of placenta (takes 30 mins for placenta) 4th stage begins with delivery of placenta and ends after 2 to 24 hours post partum Pregnancy facts Blood volume doubles (mostly plasma increase) Mothers with heart disease @ risk Urination will occur 1st 48 hours post partum (multiple times) as way to remove extra fluid volume (diurese) if not will need to catheterize (need doctors order) Fundus goes down by 1 finger breath every day post partum. Starts at umbilicus after birth. If doesn’t go down check bladder fullness. Practice Exam # 3 1. A baby with cerebral palsey may present with feeble crying when having difficulty feeding 2. 3. Snack for patient with Athetoid Cerebral Palsey would include High Energy and High Protein because they are constantly in motion and need energy 4. 4. Diagnosing Non communicating Hydrocephalus requires skull measurement and a Ventriculogram 5. hyperactivity and abdomenal pain are NOT associated with Hydrocephalus 6. Trust is the issue for a 6 month old baby. When to use Maslow vs Erikson? 7. Mother wants to know if child will ALWAYS need shunt. Answer is not within Nurses scope of practice. Should say may or may not outgrow. 8. 10 yr old Patient with epilepsy most likely would say felt funny before fainted 9. ????? 10. order is for 1.5 grains. On hand 125mg in 5 cc. How many cc given? Answer is 60 mg / grain = 90 mg / x = 125mg / 5 . 125x = 450, x = 450 / 125 = 3. 75 round up to 4.0 11. how do you feed an uncounsious patient? 12. Aldomet side effect (drug for HTN) is loss of sexual libido 13. If patient has swollen legs and concussion elevate head of bed 14. Order given for meds. 600 cc over 8 hours = 1800 cc in 24 hrs. Order says give first Liter STAT. 1 Liter = 1000 cc. 1800 / 24 = rate per hour = 75cc per hour. Quest asks how much REMAINING after first hour. Answer = 1000 – 75 = 925 cc 15. If patient with ICP were to start getting worse how would vital signs look? Answer = BP up, Pulse down, Respiration down For Shock the Vitals would be opposite BP down, Pulse up, Respirations up 16. Shining light in one eye would cause the opposite eye to respond by contracting as well. 17. An epidural hematoma is a rapid arterial bleed Decadron is used to minimize swelling for a patient with a C6 injury. Decadron is a steroid. Steroids don’t CURE ANYTHING. 18. With a C6 spinal cord injury there is a loss of arm and leg movement. This loss of movement is proof of cord involvement. 19. To perform daily care on a patient with cervical traction put hand under patients back. Do NOT MOVE patient at all. 20. To counter the weight of a patient in cervical traction raise the head of the bed six inches 21. When told to give a patient with a C6 injury an enema you would be giving a FLEET enema. A fleet enema contains about 100 to 150 cc. 22. A patient with a C6 injury might talk about his sexuality in an aggressive manner. This is the patients way of dealing with his loss of body function and counseling would be appropriate for this patient. 23. When asked how much fluid given for C6 patient for bladder training answer is 96 oz. 96 oz = how many cc’s? 30 oz / cc. 96 / 30 = 3.20 cc’s 24. What’s the priority of care for an unconscious patient? Answer is AIRWAY 25. Post op care for patient with lumbar laminectomy? Teach patient to use Trapeze to shift weight 26. Can’t lift arm after lumbar laminectomy? 28. Multiple Sclerosis patients can show inappropriate affects…..i.e. laughing when a son or daughter drops something…….. 29. To keep MS patient from slapping their foot down when they walk teach them to put their heal down first then roll their weight on the side of their foot. 30. What’s not expected from parkinson’s patient? Same skills grade from 20 yrs ago 31. Teaching the pakrinson’s patient to walk with their hands behind their back counteracts their leaning forward 32. Atrophy and destruction of cells of basal ganglia in base of brain results from Thorazine therapy in parkinson’s patients 33. Myasthenia Gravis patients need to be taught to take meds on time with milk or bread. Coffee, fruit, tomato juice changes drug action 34. Making a painful procedure easier in school age kids can be done by giving explanations of upcoming procedures 35. Meningitis is spread via nasal spray in atmosphere 36. Initial lab findings from lumbar puncture of patient with meningitis would include elevated glucose and polymoorpho nuclear leukocytes 37. Thiamine is caustic to skin. And patient with C6 injury would not feel it. Answer is to ask doctor for oral version. 38. When ICP worsens the patient would be disoriented, restless, liying in bed as if asleep, and responding to verbal instructions without question ( in that order) Steroids Used to SUPPRESS INFLAMMATION USED FOR: Addison’s Disease (Adrenocortical Insufficiency) – used for life Rheumatoid arthritis, SLE (Lupus) – Collagen Disorders Asthma – Allergic Disorders Dermatitis, Severe Psoriasis – Dermatologic Disorders Cerebral Edema, Brain Tumor, Myastenia Gravis – Neuro Conditions (use Decadron) Acquired Hemolytic Anemia – Hematologic Disorders Leukemia, Hodgkins Disease – Neoplastic diseases Ulcerative Colitis, Crohn’s Disease – Gastrointestinal Disorders Nephrotoic Syndrome (autoimmune disorder) – involves edema Chirrhosis and ascites – involves edema Optic neuritis – eye disorder Organ / tissue transplants – used as immunosuppressant to prevent rejection NURSING ACTIONS Administer accurately – orally with or after meals Observe Therapeutic Effects – Decreased symptoms Observe Adverse Effects Adrenocortical Insufficiency (Addison’s) Weakenss Nausea / Vomiting HypOtension Shock Adrenocorical Excess (Cushing’s) Moon face Buffalo Hump Hyperglycemia CNS effects Euphoria Nervousness Depression Behavior changes Musculoskeletal effects Osteoporosis Pathological fractures Muscle Weakness / Atrophy GROWTH RETARDATION in CHILDREN Cardiovascular Fluid / electrolyte effects Fluid retention Edema HTN CHF Hypernatremia Hypokalemia (need increased K found in any protein Metabolic Alkalosis Gastrointestinal Effects Nausea / Vomiting Peptic Ulcer Increased appetite Obesity Increased Susceptibility to infection / delayed wound healing Menstrual irrgularities Acne Excessive facial hair Ocular effects Increased Intra Ocular Pressure (IOP) Glaucoma Cataracts Integumentary effects Reddened skin Thinner skin / Easily injured PATIENT TEACHING Take as directed / don’t STOP ABRUPTLY Avoid stress Wear medalert bracelet No other drugs without MD order Avoid infections Avoid accidents Check weight Q 3 days or Weekly Increase K intake See MD regularly Report Stresses Sore throat Fever Weight gain Swelling Mood changes Sleep pattern changes CHEST TUBES One bottle, two bottle and three bottle systems Chest tubes are always used after thoracic surgery (exception = pneumonectomy – lung removal) Patients with chest tubes are positioned on their back or on the affected side to promote drainage All chest tube patients are encouraged to cough and deep breath Q hour. Tell them it will hurt!!!!!!!!! Use Narcotics with caution for chest tube patients. Used to take edge off only! (decreases respirations) Patients CAN get out of bed. Must have clamps at side of bed at all times but NCLEX will NEVER have you use them Most common complication: Ankylosis of affected extremity (frozen shoulder) Need to have patient perform Range of Motion (ROM) exercises Elevated CO2 causes us to breath Decreased O2 causes COPDer to breath Negative pressure in thoracic cavity allows lungs to inflate/deflate 2 tubes used in single bottle shorter tube is air vent longer tube is drainage of fluids Single Bottle system used for both drainage and waterseal Water in bottle traps air so it can’t go back into patient Water in this system WON”T bubble Water level moves up and down as patient breaths Will STOP moving if: Blockage If blocked you can milk tube ONCE If that doesn’t work need X Ray to see problem (need MD order) Lung has returned to normal expansion (time to remove tube) tape stuck to outside to mark level of water at beginning and end of shift Include time and date on tape Problem with single bottle solution Can’t tell color of drainage since it mixes with water Two Bottle System One bottle used as water seal One bottle used for drainage (connected to patient) Three Bottle System Used for suction Acts as restistance for patient as they breath. The deeper the tube in water the more resistance Can remove suction at any time = 2 bottle system SUCTION causes BUBBLING When removing chest tubes Need MD order to remove tubes Premedicate patient Instruct patient to breath in and out, then hold on inspiration Remove tubes Pneumenectomy = removal of a lung Patient does not need chest tube!! BRONCHODILATORS Adrenergics (speed up) Caution in Cardiac patients Epinephrine (Inhaler version = Primatene (frequently abused)) Fast acting 5 mins to work lasts 4 hrs given subQ in ER can repeat in 20 mins Proventil Ephedrine CNS stimulant Causes Nervousness / Insomnia Often given with Barbituates Anti – Anxiety agent Bronkosol Short Acting Lasts 1 – 3 hrs Cardiac / CNS stimulant Isuprel Alupent Brethine Long lasting Side effects - muscle tremors Xanthine (used by kids) Theophylline Prevents / treats bronchospasm Aminophylline Theodur Time released aminophylline Mixtures Quibron Includes expectorant Tedral Includes sedative NURSING INTERVENTIONS Patient Assessment Vital signs Respiratory rate / character Skin color ABG (check for hypoxia) Precipitating factors Frequency of attacks Severity of attacks Condition between attacks What brings relief Signs Respiratory distress Signs of hypoxia Cough Sputum Exercise Tolerance Medications being used Non drug therapies used Chest PT Breathing exercises NURSING ACTIONS Administer Accurately Observe Therapeutic Effects Observe Adverse Effects Cardiac Stimulation Tachycardia Palpitations Arrythmias CNS Stimulation Agitation Insomnia Headache Restlessness Convulsive Seizures Nausea / Vomiting Encourage PO fluids Liquify secretions Deep breathing Coughing Postural drainage Keep affected area to be cleared on TOP For Anterior superior lungs – Lean back (semi fowler’s) Posterior Superior lungs - Lean forward Lateral Lay on opposite side to be cleared Give mouth care AFTER postural drainage Chest PT Teach patient to avoid what brings on attacks / bronchospasms Encourage Smoking cessation Teach to avoid caffeine Help patient relieve anxiety Stay and protect patient Fourth Exam 1. Normal specific gravity and Urine pH for the exam = 1.003 – 1.030, & 4.5 – 8.0 respectively. High Specific Gravity means Hypovolemia, Low Specific Gravity means Hypervolemia 2. If father was bed wetter then most likely son would be also. Runs in family 3. Always ask how patient feels about bed wetting. 4. transmitted thru fecal material and orally. If someone has it must isolate to prevent transmission 5. If patient has pruritis its’ from bile buildup in the body 6. Tepid water bath used to treat pruritis 7. For Hepatitis A patients with Jaundice (icteric Phase meaning with jaundice) always check color of Stool or Urine which would be Grey and Dark respectively 8. 9. With Hep A liver function is decreased as noted by a decreased prothrombin blood level, Prothrombin is a blood clotting protein made in the liver. A low level means low liver function 10. Adolescence is 13 to 18. Erikson says this is the time when Friends are most important for the individual 11. It’s normal for girls who reach menarch (have their first period) to have irrgular cycles 12. A patient with head trauma the first sign of deterioration is an increase in BP 13. ICP rising can also be noted when patient has projectile vomiting 14. Mannitol (diuretic) is used to treat cerebral edema for subdural hematoma 15. When patient is ALERT and ORIENTED it’s a sign patient is improving 16. When patient having pelvic exam Nurse should teach patient to breath thru mouth to ease discomfort 17. For pregnant women teach pelvic tilt to ease back pain 18. If patient says I drink a glass of fluids (water) between meals it shows they need teaching regarding how to deal with constipation 19. Before checking position of baby when mother in active labor (to see if presenting properly) must ASK mother if she has urinated. 20. The higher the parity the earlier the membrane ruptures. Membrane should rupture before or during labor. Normal is ? 21. In response to a warm environment child’s respiration would increase to 40 breaths per minute. ??? 22. What to do for uterine pain after breastfeeding? 23. For patient with elevated bilirubin (jaundice) and receiving phototherapy make sure to TURN patient regularly 24. Post traumatic stress paitent who is mad at nurse exhibiting defiance of authority 25. If patient with post traumatic stress has hit wife first thing to ask is if he assaulted anyone else as safety measure for yourself 26. 26. 27 For an above the knee amputee (patient who had leg cut off in accident) must protect against TETANI 28 Patient with Above the Knee Amputee is turned on abdomen to avoid Constriction of Hip (weight of stump pushes leg down) 29 For patient with Above the Knee amputation there might be financial concerns. Giving referral to Social worker is part of nursing job 30 If patient with above the knee amputation expresses anger Nurse should allow patient to verbalize this anger (this is fantasy land Right? LOL) Fifth Exam 1. Less frequent urination for patient with Glomerulonephritis is due to Depressed Rate of Filtration. 2. Most important measure for patient with Blomerulonephritis is Fluid intake / output 3. Measuring the RATE of flow for this type of patient is done to prevent Cardiac Failure 4. A daily bath and frequent skin care is performed for this type of patient because the skin is an excretory organ 5. Lmiit protein for this type of patient is most likely due to Creatinine ???? ( I think creatinine is the MOST definitive test for Kidney function) 6. What is the lowest meal in terms of protein? Chicken. When asked this question and given a list of items if ONE item is wrong then even if the others are correct the entire selection is wrong. 7. A nurse shows an understanding of the important need for the patient with glomerulonephritis if they watch to see if the roommate has a cold. 8. If the BUN is elevated nurse should watch for Change in SENSORIUM = change in LOC 9. A fixed specific gravity means the kidney’s can’t dilute concentrate or dilute urine 10. Purpose of peritoneal dialysis is to elminate metabolites 11. Best position for dialyzing is on the back with head and chest elevated 12. The relationship between amount of dialyzing solution and amount of drainage is that their equal 13. A Favorable response to peritoneal dialysis is ????? 14. Terpin hydrate and Codeine are used to SUPPRESS a COUGH 15. 2500 ml given over 24 hours at 10 drops / ml = how many drops / min? Answer is 18 drops / min Answer is 2500 ml / 24 hours x 10 drops / ml = x drops / min. 104.17 ml / 60 min x 10 drops / ml = x drops / min. 1.736 ml / min x 10 drops / ml = 17.36 drops / min. Closest choice is 18 drops / min. 16. Tylenol reduces body temperature 17. What sign does a nurse look for for Infiltration? Induration 18. An early sign of Thrombophlebitis is redness and swelling 19. Earliest signs of hypoxia are restlessness and increase in BP 20. Why do patients with Pneumonia need an increase in calories? Because an increase in fever increases the metabolism 21. When person is having a seizure best response is to lay them on their side to avoid aspiration 22. The order of events for a Grand Mal Seizure are: Aura, Shrill cry, tonic movement, clonic movement, confusion, then sleep 23. The most likely behavior following a seizure is lethargy 24. What is the first thing a nurse needs to ask a patient who has just had a seizure? When was your last attack? Rationale: Patients in young adulthood (19 to 39 = intimacy vs isolation) who are in a relationship tend to stop meds thinking that they haven’t had a seizure in a long time and want to hide this from their partners 25. ????? 26. ???? 27. Phenobarbital is used in conjunction with Dilantin to? Increase the effectiveness of Dilantin 28. As a precaution for patients who have seizures an ID bracelet should be worn 29. If asked if a person with seizures will give it their children the nurse should respond by saying “we don’t know enough about whether seizures are inherited” 30. Arctane and Cogentin are used with thorazine to avoid Parkinsonian symptoms 31. The reason to spend a set amount of time with a psychiatric patient is to establish TRUST 32. Behavior early in treatment = Auditory Stimuli ???? 33. Meds are only helfpul when taken regularly 34. Stay out of the sun when taking Thorazine 35. Ask patient about why teasing ?????? 36. Likelihood of completion is aim of therapy ?????? 37. Have patient function without projection ??????? 38. Increase responsibility ?????? 39. Pt government ????? Leave for awhile then come back ??? Hypokalemia and Hyperkalemia both have early warning signs of muscle weakness, lethargy and EKG / Dsyrythmia Note: Fiber cannot be given via an NG tube Know about different kinds of diets and what they consist of I.E. Low residue diet, High iron diet What is 2,2,4,4 ? A diet is always given according to an illness first then the basic 4 used Note: Know Peritoneal and Hemodialysis Note: Know normal values for ABG’s, Na, K, CL, venous CO2, Glucose, BUN, Hematocrit, hemoglobin, WBC, RBC 6th Exam 1. Statement that best shows self image is threatened ? Might as well be dead as be half a man 2. blood test used for Prostate Cancer? Acid Phosphatase 3. For patient concerned with their catheter what would be most helpful thing nurse could do for patient? Drain cath @ regular intervals 4. Appearance of urine for 1st 24 hours after prostate surgery? Dark Red 5. If patient picking at their bed clothes what’s first thing nurse should do? Minimize source of irritation to patient 6. Why is anything involving insertion into the rectum post prostate surgery contraindicated? Because it would be trauma to operative site 7. Why is estrogen used for prostate cancer? Because it inhibits testosterone 8. How do you help a patient with scrotum swelling? Support the scrotum 9. ??? 10. If patients family asks if traction can be removed temporaily from patients broken leg how should nurse respond? Must not remove traction at all because muscle spasms can pull the bones apart 11. What is the purpose of an Open Reduction Internal Fixation? To promote early ambulation 12. What would be the best type of instruction for use of crutches? Having the nurse demonstrate use of crutches (NOT someone else with a broken leg) 13. What crutch gait would most likely be used for person with two broken legs? Four point gate (a swing thru or swing to gait is NEVER USED!!!!!) Review 3 point and 4 point gate!!!!!!!! 14. Inoperable cancer of the bowel?????? 15. Controlling odor in a room????? 16. Which is part of a high protein low gas diet? ?????? Avoid high fiber to avoid gas 17. whish is high in fiber and gassy? Cole slaw (not celery, boiled eggs, or carrots) 18. manifestations of glaucoma loss of peripheral vision 19. purpose of surgery treatment for glaucoma to improve drainage of acqueous humor 20. why is there a diet after glaucoma surgery? To prevent straining (increasing Intra ocular pressure) 21. Patient teaching for Glaucoma Treatment thruout life will be needed 22. how do you effectively control hemorrhaging of a severed foot? Apply tourniquet above amputation site 23. Most common complication of surgical amputation? Hemorrhage (Not infection or embolism) 24. ??????? Allow movement in bed without alteration of line of traction 25. What about traction requres immediate correction? The leg laying on the bed 26. Best way to move a leg in a cast? Support the cast with the palms of both hands 27. indication of developing infection? Pain 28. Skin care for a stump? Making it rough and leathery? Must get it ready for a prosthesis! NOTE : Review Colostomies!!!!! 7th Exam 1. How do you ID the major symptom of dehydration in an infant? Palpate anterior fontanel 2. Which info is most revealing of hydration status? No diaper change in 4 to 6 hours 3. Which is most typical of vomitus seen in infants with pyloric stenosis Forcefully ejected and made of curdled milk 4. Metabolic Alkalosis is assessed by? Character of Respirations 5. Parents don’t understand what doc said about pyloric stenosis surgery. What does nurse say? It’s the cutting of tight muscles at lower end of stomach (NOT NERVES) 6. What strongly indicates to much fluid in infant via IV? Lower respirations? (also same in elderly). Always use Buretrol for babies !!!!! 7. What is most likely to be seen in a 7 week old? Lifting head from prone position 8. What’s the greatest consideration in comatose patient? Absence of cough, gag, swallowing reflex (Think AIRWAY) 9. Measures used in care of unconscious patient? Full range of motion for joints 10. measures used in care for patient on Mannitol? Foley cath inserted? (must measure output) 11. What does nurse do if fluid coming from nose of comatose patient? Use Sterile Pad under nose (send for culture and sensitivity to look for infection in CSF) NEVER SUCTION!!!!! 12. Purpose of eye care for comatose patient? To prevent corneal ulceration (patient NOT blinking) 13. Best position for arm in comatose patient with arm weakness? Slightly adducted Elevated with one pillow Elbow slightly flexed Wrist extended Fingers slightly flexed 14. which serum test for extensive glomeruli destruction? Creatinine (best indicator for ANY kidney problem) 15. What action to take BEFORE peritoneal dialysis? WEIGHT for baseline 16. What action to take NEXT after peritoneal dialysis with 600 cc still left in patient? Turn patient on left or right side to remove remaining fluids 17. Most significant indicator peritoneal dialysis working? Review Peritoneal and Hemodialysis Potassium level (Potassium excreted by kidneys!!!!! 18. Major goal of care for 6 yr old with sickle cell anemia Promote HYDRATION to PREVENT Sickle Cell Crisis 19. Which comment made by parents of sickle cell anemia should nurse discuss with parents? Parent says can’t wait to take child to play baseball. (must inform parents that joint injury could cause problem with sickle cell (possible crisis) NOTE: Enuresis common in sickle cell patients 20. Parents ask for chances of passing on sickle cell anemia if both parents have trait? 25 % chance since need both parents with recessive gene to pass onto child NOTE: 50% chance newborn will be carrier 21. Which is an essential assessment with a 27 yr old whose had first delusion? Does he have destructive impulses (need to know if you’re safe to be with them) 22. Whats’ therapeutic response to patient saying “They’re out to get me”? Acknowledge fears but that they are not threatening 23. Nurse tells psych patient “time to take meds!” What should the nurse have done differently? Stated it more unambiguously. I.E. the doctor said time for you to take thorazine Other way patients’ paranoia can take over. 24. what’s goal to establish at beginning of psych patients treatment? ESTABLISH TRUST 25. Which behavior shows patient is giving up delusions? Patient suggests test to determine if someone out to get him. 8th Exam 1. In a patient with bleeding peptic ulcer what statement is true? It’s aggressive drives turned inward 2. ?????? Autonomic Nervous system and Adrenal Glands 3. patient is using the call bell a lot. Knows they’re being difficult and tells that to nurse. What should response be? Yes you’re making a lot of requests you must be uncomfortable 4. Best way for nurse to maximize?????? Recognize own feelings 5. ?????? Understanding and support 6. Anxiety in patient with ulcer is: Associated with unconscious conflicts 7. Behavior characterized by guilt and suicidal tendencies Periods of crisis ????? 8. Anxiety in depressed patient is established ? In early childhood (trust vs mistrust) 9. Ambivalence is handled by? Rationalization 10. Therapeutic care for a depressed patient? To talk about plans for suicide 11. When working with depressed patient keep in mind all EXCEPT: Verbalizations of suicidal intent substitute for action 12. Greatest effect of suicide determined by: Significance of familial role 13. Drug for depression? Tofranil 14. Contraindication for Tofranil Cardiac and glaucoma 15. What’s NOT seen in post suicidal attempts? Agitation 16. ????????? Simple consistent non challenging routines 17 which least likely to be present in patient with depression? Exhaustion 18. Suicide attempt represents need to? Punish himself 19. Group activities are difficult for the depressed individual because? Patient is preoccupied with his own discomfort Emotionally and physically fatigued Feels inferior to the rest of the group 20. A therapeutic response to “ nothing in life is worth all the trouble I’ve had” would be? You feel dying is easier than living? 21. Patient asks wife for divorce what does nurse do? Allow wife to express feelings 22. Ms. Gordon can’t understand the doctors explanation of surgical procedure ??????? 23. Ms. Gordon has interference with cortical metabolism. All but what is exhibited in her behavior? ????? 24. Nursing approach to Ms Gordon is? Showing ojbective responses to her behavior 25. Patient is eating with her hands, best way to handle this is to? Cut food for her and encourage her to use utensils 26. most significant factor underlying her behavior? Basic personality prior to her illness 27. What statement on mental illness is NOT true? Indicates inability to adapt to stress (ALL BEHAVIOR has MEANING. The MEANING is to REDUCE ANXIETY!) 28. why does industrial society with increased income and higher standards of living benefit people? Able to afford more and better health care. (REMEMBER THIS IS FANTASY LAND) 29. The gratification of basic needs for survival….. ??????? 30. Freeing individuals to develop basic concepts in knowing human behavior is? ????? 31. When exploring patients anxiety the objective is to help patient? ????? 32. ?????? Nurses anxiety prevents her from hearing the patient 33. to use therapeutic concepts its’ most necessary to?????? Increase the number of mental health nurses 34. The sign of an integrated personality is? Coordination between doing and feeling Cholinergic Drugs Definition: Stimulates parasympathetic nervous system Effects on Body Decreased HR Vasodilation Unpredictable changes in BP (opposite of Anticholinergics Increased tone / contractility in GI smooth muscle, relaxation of sphincters, increased salivary gland / GI secretions Increased tone / contractility of smooth muscle (detrussor – muscles surrounding Bladder) in urinary bladder, relaxation of bladder sphincter Increased tone / contractility of bronchial smooth muscle Increased respiratory secretions Constriction of pupils and contraction of ciliary muscle Clinical Use Relief of Urinary retention Post Op paralytic Ileus (blockage due to paralysis of bowel wall) Glaucoma Contraindications Urinary / GI obstructions Asthma, peptic ulcer, coronary artery disease, hyperthyroidism, pregnancy, inflammatory abdominal diseases Drugs Bethanechol (Urecholine) Relieves urinary retention, gastric atony (lack of tone, flaccid), paralytic Ileus, gastroesophageal reflux from hiatal hernia Neostigmine (Prostigmine) Tx of Myasthenia Gravis (neuromuscular junction has no acetylcholine causing fatigue and muscle weakness. Drug increases acetylcholine increasing muscle strength) Pulse rate must be above 80. Drug causes decrease in BP Tensilon Mastinon Antidote for Cholinergic Crisis = ATROPINE Cholinergic Crsis = Occurs as result of overmedication of Anticholinesterase. Sign / symptoms Weakness Difficulty swallowing, chewing, speaking, breathing Apprehension, N/V Abdominal cramps Diarrhea Excessive secretions, saliva Bronchial spasm May need intubation / venting TX: Discontinue cholinergic drugs, 1 mg Atropine Myasthenic Gravis Crisis = Caused by undermedication Sign / Symptoms Increase in BP Increased HR Severe Respiratory Distress / Cyanosis Absent cough / swallow reflex Increased secretions, diaphoresis, lacrimation (tears) Restlessness Dysarthria Bowel / bladder incontinence If increase in Anticholinesterase drugs does not help Tx is Endotracheal Intubation / vent. Usually clears up in 24 to 48 hours. Reduction by Traction Definition: Steady pull on part of body. Used to reduce / immobilize fractures overcome muscle spasm stretch adhesions correct some deformities When used to treat fracture: Traction and countertraction used to keep bone fragments touching (in alignment) Need Dr. order Types of traction: Skin Traction Application of wide bands of moleskin, or adhesive to skin + weights Buck’s Extension Simplest form of traction Straight pull on extremity (usually temporary) Russell Traction Permits patient to move in bed Permits bending of knee Used for fractured femur in elderly when surgery contraindicated Skeletal Traction Applied directly to bone in OR Balanced Suspension Used WITH skeletal or skin traction Allows patient more freedom to move in bed without disturbing line of Traction Nursing Care Examine skin frequently for pressure or friction Observe for signs of: Thrombophlebitis related to inactivity or pressure Traction pull or alignment Altered skin sensation of parts distal to traction Inability to move toes Check : Peripheral pulses Color Temperature of distal parts to traction Inspect PIN site for infection Maintain traction and countertraction NEVER release or alter traction Movement in bed depends on injury and type of traction Weights MUST hang free Footplate must NEVER push against the foot of the bed (negates traction) Ropes must run free in pulleys Promote Nutrition Protein & Vit C (also carbs?) Promote elimination High fiber, fluids, ambulation when possible Open Reduction Internal Fixation Used to promote early ambulation Surgical procedure to repair fracture Pre Op Care Pain meds Traction Good body alignment Skin care Assist with position changes Pre op teaching Post Op Care Possible traction Prevent complications Deep breathing / coughing Monitor Vital Signs Check peripheral pulses Observe thrombophlebitis Range of Motion exercises Inspect dressing Ambulation usually on FIRST POST OP DAY!!!! Fractures Definition : interuption in bone continuity Immediate Management Splint before moving (immobilize) Elevate to minimize edema Observe @ freq intervals for: Changes in color, sensation, temperature Tingling, numbness, burning pain (nerve injury) Coldness, blanching, cyanosis (circulation) Increased warmth / swelling (infection) Edema (poor venous return) Early signs of shock (Vitals Q 15 mins prior to ER) Misc Management techniques Tetanus if compound (thru the skin) fracture. Open wound increase in possible infection Cold application ordered within 24 hours to reduce hemorrhage, edema (after 24 hrs no good, need MD order) Pain meds Subsequent Care of fracture Immobilization with reduction (bone back in place) by closed reduction (traction), open reduction (surgery) or internal fixation (pins, screws etc) Cast Care Post Op Support wet cast with flat or palm of hands Place patient in cast on firm mattress with bedboard under mattress Support cast on pillows to prevent flattening Allow cast to dry by evaporation via circulating air (don’t cover) Use hair or cast dryer but never on hot Blankets to protect body only Turn patient Q 2 hours Dr order needed to turn to injured side Do not paint varnish shellac cast (cast porous) Patient care Postoperatively Admin pain meds Skin care Prevent DVT, Pulmonary embolism, hypostatic pneumonia Use trapeze to assist in movement in bed Encourage active ROM of extremeties NOT in cast Turn patient as per DR orders Encourage deep breathing / coughing ADL’s Use fracture bed pan Encourage self care Constiaption More fiber, fluids, ambulate when able Patient Teaching Never insert sharp objects under cast Weight bearing not permitted without Dr order Avoid weight GAIN